title: Advantage of microscope integrated for both indocyanine green and fluorescein videoangiography on aneurysmal surgery: case report.
abstract: Neck clipping of a large middle cerebral artery aneurysm was performed using a newly developed surgical microscope integrated with modules for both indocyanine green (ICG) and fluorescein videoangiography. During surgery, ICG and fluorescein videoangiography by intra-arterial or intravenous injection were safely carried out without interrupting the surgical procedure. Based on the findings obtained from the case, we evaluated the differences between the dyes and the injection routes. With intra-arterial injection, fluorescein offered sharper contrast images and was better at depicting fine arteries than ICG. Patchy staining of vessel walls was observed in intravenous fluorescein videoangiography, while it was not evident in ICG. Intra-arterial injection method had a great advantage in the rapid clearance of the dyes, which allowed us to perform repeated videoangiography within a short period, and was useful in detecting incomplete clipping in this case; however, catheter insertion requires additional work and carries a potential risk. Use of a microscope integrated for both ICG and fluorescein videoangiography would be another method for repeated evaluation. Namely, alternate use of the dyes enables us to perform videoangiography in a short time even via intravenous injection.
authors.affiliation: Department of Neurosurgery, Interdisciplinary Graduate School of Medicine and Engineering, University of Yamanashi.
authors.forename: Hideyuki
authors.initials: H
authors.lastname: Yoshioka
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Kinouchi
authors.forename: Yoshihisa
authors.initials: Y
authors.lastname: Nishiyama
authors.forename: Kazuya
authors.initials: K
authors.lastname: Kanemaru
authors.forename: Takashi
authors.initials: T
authors.lastname: Yagi
authors.forename: Mitsuto
authors.initials: M
authors.lastname: Hanihara
authors.forename: Toru
authors.initials: T
authors.lastname: Horikoshi
mesh_terms: D002533:Cerebral Angiography / Q000295:instrumentation*; D005260:Female; D005451:Fluorescein Angiography / Q000295:instrumentation*; D006801:Humans; D007089:Image Enhancement; D007208:Indocyanine Green; D007269:Injections, Intra-Arterial; D007275:Injections, Intravenous; D002532:Intracranial Aneurysm / Q000601:surgery*; D008866:Microsurgery / Q000295:instrumentation*; D008875:Middle Aged; D011856:Radiographic Image Enhancement / Q000295:instrumentation*; D020535:Video-Assisted Surgery / Q000295:instrumentation*
chemical_list: D007208:Indocyanine Green